Assessing and improving teamwork in cardiac surgery

Schraagen, Jan Maarten; Schouten, Ton; Smit, M; Haas, Felix; Beek, D. van der; Ven, J.G.M. van de; Barach, Paul

doi:10.1136/qshc.2009.040105

Cited by 45 publications

(27 citation statements)

References 36 publications

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“…They also facilitate collaborative analysis. Additionally, video recording had been used successfully in a number of studies concerned with the impact of teamwork on surgical performance, 28,[77][78][79][80][81][82][83][84][85][86][87] providing a useful set of background materials with which we could compare and contrast our findings.…”

Section: Video Recordingmentioning

confidence: 99%

A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

Randell

Honey

Hindmarsh

et al. 2017

Health Serv Deliv Res

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Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 12/5005/04. The contractual start date was in September 2013. The final report began editorial review in September 2016 and was accepted for publication in February 2017. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department...

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Section: Video Recordingmentioning

confidence: 99%

A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

Randell

Honey

Hindmarsh

et al. 2017

Health Serv Deliv Res

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“…As indicated in the introduction, several groups have independently developed approaches similar to ours,6 16 18 19 26 all with differing taxonomies with analogous loci of focus. This ‘convergent evolution’ has, we believe, been driven by the need to develop a tool which preserves the rich data collection possibilities of direct observation without being impossibly unwieldy for live use in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

“…To conduct high-volume comparative evaluations of interventions to improve operating theatre safety and reliability, we needed direct observational methods to measure process fidelity which are applicable across a wide range of specialties, techniques and settings, not making assumptions about causality and not attempting to estimate the impact on outcome. Direct observation methods for evaluating theatre team technical performance have been published by others6 16 18 19 and the principles used are very similar in several of these to those on which we had based some of our own previous work 4 18. Rather than tackling the difficulties of learning, adapting and validating a new system, we decided to develop our own based on our previous studies.…”

Section: Introductionmentioning

confidence: 99%

Capturing intraoperative process deviations using a direct observational approach: the glitch method

Morgan

Robertson

Hadi³

et al. 2013

BMJ Open

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ObjectivesTo develop a sensitive, reliable tool for enumerating and evaluating technical process imperfections during surgical operations.DesignProspective cohort study with direct observation.SettingOperating theatres on five sites in three National Health Service Trusts.ParticipantsStaff taking part in elective and emergency surgical procedures in orthopaedics, trauma, vascular and plastic surgery; including anaesthetists, surgeons, nurses and operating department practitioners.Outcome measuresReliability and validity of the glitch count method; frequency, type, temporal pattern and rate of glitches in relation to site and surgical specialty.ResultsThe glitch count has construct and face validity, and category agreement between observers is good (κ=0.7). Redundancy between pairs of observers significantly improves the sensitivity over a single observation. In total, 429 operations were observed and 5742 glitches were recorded (mean 14 per operation, range 0–83). Specialty-specific glitch rates varied from 6.9 to 8.3/h of operating (ns). The distribution of glitch categories was strikingly similar across specialties, with distractions the commonest type in all cases. The difference in glitch rate between specialty teams operating at different sites was larger than that between specialties (range 6.3–10.5/h, p<0.001). Forty per cent of glitches occurred in the first quarter of an operation, and only 10% occurred in the final quarter.ConclusionsThe glitch method allows collection of a rich dataset suitable for analysing the changes following interventions to improve process safety, and appears reliable and sensitive. Glitches occur more frequently in the early stages of an operation. Hospital environment, culture and work systems may influence the operative process more strongly than the specialty.

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“…[15] Simulation-based training has also been shown to enhance physician's performances during weaning from CPB. Immersive training focusing on nontechnical skills are believed to be superior to passive discussion in traditional interactive teaching seminars.…”

Section: Organizational Aspects and Human Factorsmentioning

confidence: 98%

Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

Licker¹,

Diaper²,

Cartier³

et al. 2012

Ann Card Anaesth

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A sizable number of cardiac surgical patients are difficult to wean off cardiopulmonary bypass (CPB) as a result of structural or functional cardiac abnormalities, vasoplegic syndrome, or ventricular dysfunction. In these cases, therapeutic decisions have to be taken quickly for successful separation from CPB. Various crisis management scenarios can be anticipated which emphasizes the importance of basic knowledge in applied cardiovascular physiology, knowledge of pathophysiology of the surgical lesions as well as leadership, and communication between multiple team members in a high-stakes environment. Since the mid-90s, transoesophageal echocardiography has provided an opportunity to assess the completeness of surgery, to identify abnormal circulatory conditions, and to guide specific medical and surgical interventions. However, because of the lack of evidence-based guidelines, there is a large variability regarding the use of cardiovascular drugs and mechanical circulatory support at the time of weaning from the CPB. This review presents key features for risk stratification and risk modulation as well as a standardized physiological approach to achieve successful weaning from CPB.

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Assessing and improving teamwork in cardiac surgery

Abstract: PCS is an ideal model to explore team performance. A challenge for the future is to make observations of teamwork in healthcare settings more efficient and robust.

Cited by 45 publications

References 36 publications

A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

Capturing intraoperative process deviations using a direct observational approach: the glitch method

Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

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